"Needless Death" is a poem written by the author which describes a situation where the problem of poor employee health is evident.

"Needless Death"

Living in a world of stress and underpay,
the worker goes to earn his wage,
he does not care how he weighs,
does not bother of leaving his cage
that he spends the dreary weekends in watching games.
Eating, smoking, and drinking get him going,
he knows this will never get him any fame
but all is well for him if he keeps on flowing
in his river of physical shame.

The boss is afraid,
his risks are great and could be high-priced
if no one starts going to his aid
this worker will end up in a grave.
No one wants to see him fade
but nothing will change the stubborn man’s mind.
Words of wisdom do not enter his brain,
exercise programs will help him escape his bind
but he complains he doesn’t have time even to watch the rain.
There are not many more times the clock will be wind.

Tick, tock, the clock strikes twelve,
the body has given up the battle,
sirens rush to the dwelling
but everyone is much too late.
So much story telling
of how this man lived a life of decay,
Never listening to advice or hints
people said his stomach bulged like a bale of hay
but his determination to suffer was sharp as flint.

The boss begins to think of all the training,
all the years and wages,
numerous dollars he was gaining
Managed even to get through all the manager’s rages
the role of executive was even in reach of obtaining
so much productivity gone with one man’s fate
The process must start anew
A future employee will not make the same mistake
He will not die at thirty-eight.

B. Methods of Research

I. Collection of Data

I will take notes on fiction books when I write my report and will write take notes as I am reading the nonfiction books. If I believe a certain subject will help me answer any of the subquestions, I will write down a sentence or two on a notecard. I will also indicate where the information came from.

II. Organization of Data

I will divide the notecards according to which book they are written about. I will write the source’s title and page number on the top of the notecard.

III. Management of Data

I will store all the notecards in a filing box and divide them with other notecards. I will keep the filing box at home since I will be doing most of my research there. I will also have a 3-ring binder to hold print outs of book titles and internet sources.

Synopsis: The setting is in Manchester, England, in the 1840’s. There is a lot of pollution and poverty in the city. Death and disease are very common. Mary Barton watches her mother die after childbirth and several other relatives die of disease. She works as an apprentice to a dressmaker, Margaret, with the hope of becoming one herself someday. Her father earns a living by working in factories and can barely afford to buy food for the family.

Mary is the object of affection for two men, Jem Wilson and Harry Carson. Jem works in the factories like John Barton, but Harry is the son of a mill owner and is considered to be in a higher class than the Bartons or the Wilsons. Jem often visits the Barton house to see Mary, but Mary does not have the same feelings for Jem. Jem even asks Mary to become his wife, and is extremely disappointed when she says she cannot love him. Harry also tries to court Mary and is also turned away, but he believes Mary will change her mind eventually because he is in the upper class.

Jem and Harry have an argument in the streets about Mary and they almost have a fight. There is also tension between them since Carson's mill burned down, but Messsrs Carson is in no hurry to rebuild since his products were not in high demand and insurance would allow him to improve his equipment to first rate standards. Since the mill is not operational, many of the men are unemployed and cannot afford to buy food for their families. John Barton and Jem’s father have a hard time finding work. Harry is then found murdered and Jem is accused since the gun used in the crime belonged to him. Everyone thinks Jem committed the murder, but Mary has an alibi for Jem. Mary knows the real murderer was her father and he had borrowed the gun from Jem. Mary is unable to testify in court because she goes mad, but Will Wilson is able to tell the jury that Jem was in Liverpool the night of the murder because he was visiting his uncle. Mary finally falls in love with Jem, and Jem plans to marry her once Mary recovers from all the stresses of the trial. John Barton is never put on trial, but tells Harry’s father that he has had to undergo much more misery than death. John Barton finally dies of natural causes.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?

In this book, the people who were working in the factories had far more illnesses and early deaths than those who owned the mills or factories.

2. What were the first signs that society was undergoing a change in its health?

Did not address

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

Did not address

4. What was the effect of more people working in offices instead of places where good health was a necessity?

Did not address

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

Factory workers were easy to replace.

6. What guidelines do experts give for a healthy lifestyle?

Did not address

7. Can elderly people meet the same demands as younger people?

Did not seem to be any difference between young and old factory workers.

8. Should regular exercise be a required part of worker’s daily lives?

Did not address

9. Is there a particular era when people’s lifestyles changed?

The characters in this novel had poor nutrition habits mainly because they had to eat whatever they could find. Exercise was not really necessary since people worked long hours each day and had chores to do at home. Smoke from all the factories created a very unhealthy environment.

Comments

Disappointed book dealt with personal relationships more than the environment in the factories. When I saw the cover with all the smoke stacks on it, I was thinking it would deal with life in the factories.

List of Characters
Dr. John Harvey Kellogg-founder and leader of Battle Creek Sanitarium
George Kellogg- adopted son of the doctor who is a troublemaker
Will Lightbody- recovering alcoholic who comes to the Sanitarium
Eleanor Lightbody- husband of Will, believes everything the doctor says
Charlie Ossining- entrepreneur in the health food industry
Mrs. Hookstratten- invests several thousand dollars in Bender and Ossining’s business
Goodloe Bender- head of Kellogg’s Per-Fo company
Nurse Graves- one of Will’s nurses

Synopsis: Battle Creek, Michigan, in the early 1900’s, has become the health-food capital of the United States. Battle Creek features several cereal companies along with Dr. John Kellogg’s Sanitarium where rich Americans go to cure their ills. The Sanitarium preaches the evils of meat, sex, and alcohol. Patients are often forced to undergo very strange diets, such as eating only grapes or drinking milk, and have stomach performed often to cure what ails them.
No one even begins to question the authority of Dr. Kellogg even in matters that are often amusing. There are three plot lines in the novel.

Eleanor and Will Lightbody stay at the Sanitarium for over a year. They left their New Jersey home after their baby was stillborn and Will had become an alcoholic. Eleanor wants to do everything possible to get well and follows the instructions of Dr. Kellogg precisely. Will, on the otherhand, is more of a rebel and drifts from the instructions of the nurses. He thinks Dr. Kellogg is crazy when he says that he should not have sex with his wife and hates the food that he is forced to eat. The Lightbodies are forced to stay in separate quarters which ends up almost causing them to separate permanently. Will becomes very fond of Nurse Graves and is delighted to spend any time with her. The nurse tries to tell Will that they cannot have a personal relationship. Will even thinks about leaving the Sanitarium and taking Nurse Graves with her, but he is devastated to learn that she will be getting married soon. Will becomes aware that Dr. Kellogg’s methods are not working when he sees a friend electrocuted in therapy. He begins to fight the system and wants to leave, but Eleanor refuses. Meanwhile, Eleanor starts to learn about new health practices outside the Sanitarium in Battle Creek that include "the manipulation of the womb" and sunbathing in the nude. Her husband goes crazy when he learns this from following her around and by talking with Dr. Kellogg. Will learns she is practicing these methods with another woman and two men. He finds the group and then beats the men with a stick and takes Eleanor with him. They do not even return to the Sanitarium and head straight home to New Jersey where they give up their foolish practices.

The second plot line involves the conflict between George Kellogg and his adopted father. Dr. Kellogg has over twenty adopted children staying with him, but George is the only that makes trouble. Dr. Kellogg took him from the streets of Chicago when was six years old and wanted to prove that the environment had a greater effect than heredity. There are several flashbacks involving George’s childhood troublemaking. George gets involved with the Per-Fo company only because of his name. He is a regular drunk that gets thrown in jail often. In a final confrontation between Dr. Kellogg and George, the doctor pushes George into a peanut butter vat after a long fight throughout the Sanitarium. George had already burned down the Sanitarium once when was 13, but nobody blamed him, and tried to do it again in front of his adopted father. Dr. Kellogg tells others nothing about he killed George in pure anger. The Sanitarium remained open until the Great Depression and then was turned into a hospital.

The third plot line involves Charlie Ossining, Goodloe Bender, and George Kellogg. The three get together in hope of becoming rich with the Kellogg name. They thousands of dollars in capital, but are never able to get the business off the ground. Bender tells Ossining that he is going to travel around selling the cereal, but he stiffs Ossining and takes the money with him. He lays all the blame for the lost investments on Ossining. Ossining is a wanted man in Battle Creek and is finally caught at the Sanitarium when is he trying to get more money out of Mrs. Hookstratten. He escapes from custody of the sheriff when the carriage he is riding in is involved in an accident with a Cadilliac. He manages to get his handcuffs off and eventually becomes very successful producing Per-To. This is a product that is 40% alcohol and claims to cure all ails.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?
(patients in this case)
Dr. Kellogg had a tendency to blow illnesses out of portion. For instance, when Will was hung over from drinking the doctor said he was in danger of dying. Most patients at the Sanitarium 1did not get better and a few died. Most of the people at the Sanitarium were very rich.

2. What were the first signs that society was undergoing a change in its health?

The turn of the century was a big turning point in terms of nutrition. C.W. Post, Kelloggs and several other names come form this era. Although some of the health practices were to extreme, the doctor started many health principles that are heard today, such as eating a lot of fiber and avoiding red meat.

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

The turn of the century in this case. Exercise was a regular activity at the Sanitarium although many of the practices were very strange. Developments in nutrition expanded rapidly and had a greater influence on the public then the exercise practices.

4. What was the effect of more people working in offices instead of places where good health was a necessity?

Not addressed

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

Not addressed

6. What guidelines do experts give for a healthy lifestyle?

Exercise, vegetarianism, abstaining from sex, eating a lot of fiber, elimination of alcohol, and avoiding tobacco were all preached by Dr. Kellogg.

7. Can elderly people meet the same demands as younger people?

Not addressed

8. Should regular exercise be a required part of worker’s daily lives?

Exercise was required of all patients at the Sanitarium. Dr. Kellogg also exercised everyday.

9. Is there a particular era when people’s lifestyles changed?

Although there were only very rich people staying at the Sanitarium, the health food market did effect all Americans at the turn of the century. The basic principles of Dr. Kellogg are still found today but not nearly as extreme.

Comments

I found this book very enjoyable to read. Since it is historical fiction, it also should be helpful with the cause paper. The problem with practices at the Sanitarium was the lack of moderation. Hippocrates warned against changing one’s diet completely, even if it was poor, because of the health effects that would follow. It is easy to laugh at the practices during this era, but I am sure that many of exercise gimmicks and diet plans today are just as foolish and waste of money as those done at the Sanitarium. People like Charlie Ossining and Goodloe Bender will always be looking to make a quick buck and in most cases will be successful because of the American public’s want of instant gratification.

Synopsis: Pelletier begins the book by talking about the money wasted because of employees who die unexpected deaths. He writes about how smoking cost companies millions of dollars each year in absenteeism and lost wages. Xerox estimates the loss of an executive at age forty-nine will cost the company $600,000. Pelletier talks about how we are trying to help those who are sick and have diseases, but do very little when dealing with health promotion. Very few companies reward people for staying healthy.

When promoting a healthier lifestyle, Pelleitier recommends companies work together with employees instead of saying they will do everything for the individual. Companies should provide reasons to the employees about why they should be living healthier. No health promotion program will be successful unless everyone agrees there is a need for one. Changes in the working environment should also be implemented. Vending machines should have healthy food and smoking should not be allowed. Rewarding people for their efforts is also a good idea. The Hospital Corporation of America in Nashville pays their employees twenty-four cents for each mile they run, six cents for each mile they bike, and sixteen cents for each mile they swim.

The cost of health promotion is very important. Pelletier recommends companies makes use of local facilities, such as the YMCA, when starting exercise and nutrition programs. This also makes the company more connected to the community. It is very important health programs are profitable. A Health Maintenance Organization has become popular with large companies. The Ford Motor Company saved two million dollars in 1978 from HMO participation by 10,000 employees, which is only four percent of its U.S. work force.

Answers to Questions

1 . Where is the problem of unhealthy employees, mentally or physically most evident?

Wherever health promotion is not emphasized, there will always be a large percentage of unhealthy employees. Also where there are toxic substances such as asbestos, lead, or benzene, there will be a great increase in sickness.

2. What were the first signs that society was undergoing a change in its health?

In a 1961 Gallup poll, 24% of adults indicated they exercised regularly. In a 1977 poll, 47% said they exercised regularly.

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

Only information same as above.

4. What was the effect of more people working in offices instead of places where good health was a necessity?

Not addressed

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

Smokers cost employers around $27.5 billion per year. Alcohol abuse cost employers $44.2 billion. General Motors spent more money on health insurance and disabilities than on steel in producing cars. These costs added $175 to each employee in 1979.

6. What guidelines do experts give for a healthy lifestyle?

A health promotion program cannot be limited to only physical exercise or it will not be effective. A healthy lifestyle has to include good nutrition, stress management, and exercise.

7. Can elderly people meet the same demands as younger people?

Not addressed

8. Should regular exercise be a required part of worker’s daily lives?

It is recommended the worker and employer both agree regular exercise should be a part of his or her daily life. The worker will be less eager if required.

9. Is there a particular era when people’s lifestyles changed?

Statistics in question #2 only information.

Comments

This book was very helpful because it gave a number of statistics. The only drawback was it was written in 1984 and obviously a lot of things have changed since then. I could compare the late 70’s and early 80’s health promotion with the present day and see what worked and did not work.

Synopsis: Cooper writes about many examples of organizational health experiments which have taken place in the United Kingdom in the last few years. In the introduction he writes physical health includes fitness, diet, disease, injury, medication, lifting, and handling. The four elements of organizational health are environmental factors, physical health, mental health, and social health. Cooper believes a health work organization must be able to measure its progress, or you cannot tell if you achieved the results you desired. He mentions although the working environment has made great strides in the last fifty years, conditions are still are not ideal.

One process many organizations use is a screening service. A screening service can provide employees with detailed information about their health and identify the factors which put their health at risk. This allows certain people to be given more attention than others if they are in a high risk group for illness. An organization must communicate with their employees and tell exactly why and how they are doing certain things, or health promotion will likely fail. Cooper adds people respond and give their best when they work together. It is very important the program is preventive instead of just playing the role of treating sickness and disease.

A physical health assessment is based on the following factors: previous health problems, height/weight/body mass index, flexibility, back and grip strength, and stamina. In one case study at the Nestle Rowntree in York, England, males ages 30 to 39 had the highest percentage of attendance of any group at the fitness center the company provided. Cooper writes local resources should be used whenever possible.

Cooper goes on to talk about the many aspects of stress. He found pressure from the job itself seemed to affect women more than me. He points out stress is not necessarily bad, but must be managed in order to be used effectively. Cooper also provides more definitions of health. A state of complete physical, mental, and social well-being, not merely the absence of disease is one definition. Cooper’s checklist for organizational physical health is the following: health screening programs are available, the organization runs health education programs, there are facilities for exercise, and healthy eating is encouraged.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?

Wherever health promotion is not stressed, there will always be a large amount of unhealthy workers. Males ages 30-39 attended the fitness center at Nestle Rowntree most frequently, so this age group likely has the least amount of physical health problems.

2. What were the first signs that society was undergoing a change in its health?

Cooper only writes the working environment has improved greatly the last fifty years.

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

Did not address

4. What was the effect of more people working in offices instead of places where good health was a necessity?

Did not address

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

45% of all premature deaths of working people between ages 35 to 64 are caused by heart disease. U.S. industry loses about 550 million working days each year because of absenteeism. 54% of those absences are because of an unhealthy work environment.

6. What guidelines do experts give for a healthy lifestyle?

A health promotion program cannot be limited to only physical exercise or it will not be effective. A healthy lifestyle has to include good nutrition, stress management, and exercise. Management of stress is very important for health organizations. Cooper writes good health is everyone’s responsibility and health promotion starts at the top.

7. Can elderly people meet the same demands as younger people?

Did not address

8. Should regular exercise be a required part of worker’s daily lives?

A health organization will only succeed if everyone works together.

9. Is there a particular era when people’s lifestyles changed?

Did not address

Comments

The book was at times very technical, but Cooper did provide some good points. I found many of the same things which were talked about in Healthy People in Unhealthy Places. Some of the definitions of health and physical health should be useful for the definition paper. I am finding physical health alone cannot improve efficiency, so I might need to change some terms. I do not want to get too involved with mental and psychological subjects because the research area would be too broad.

Synopsis: Goldstein begins the book by writing about the origins of the health movement. He lists improvements in medicine and technology as major factors for the beginning of the health movement. He also notes that religion has been very supportive of the health movement throughout history.

Goldstein then talks about the ideology of health. Personal responsibility and the idea that we have control of our destiny in health matters are two important ideas brought up. Another ideology belief is that health is harmony with nature. The author reasons that natural rhythms of daily life were disrupted with the stresses of a career and urban environment. Goldstein writes the value of taking preventive action over the value of curing illness is agreed upon by all elements of the health movement. One of the values of American society that go against the health movement is the belief in consumption and instant gratification.

The next chapter in the book deals with the history of nutrition and body shape. In colonial America, the overconsumption of food was associated with an inability to take on the responsibility of work. By 1900, there was an emphasis on being slender. The first official U.S. food guidelines were published in 1916 by the Department of Agriculture. Goldstein notes that the emphasis on being slender by the health movement has been condemned by feminists and other groups. An awareness of good nutrition habits has been found to have little or no carry-over with daily life.

The next section deals with the history of exercise. Americans have longed believed that exercise helps enhance the ability to work hard. In the 1830’s, Americans already were startin to believe that the population was becoming week. Henry David Thoreau is quoted saying, "I never feel that I am inspired unless my body is also." In 1960 the general medical opinion finally believed that exercise would be beneficial for most people. The failure of the U.S. in Vietnam also caused a belief that America was becoming weak and needed to work harder. Exercise was a possible solution to this. Goldstein writes that exercise is the health movement’s most visible positive symbol. Americans give lack of time and discipline as reasons for not exercising.

The decline of smoking in America is another impact of the health movement. After 1970 the antismoking movement grew rapidly and impacted society substantially. Religious groups have long preached against the evil effects of smoking. Goldstein then talks about who participates in the health movement. He writes that women, the more educated, and the middle class are most likely to be knowledgeable about health-related matters and to engage in health activities. The proportion of adults who are active declines with age and the steepest drop occurs in early adulthood. Women are generally more positive about participating in health activities.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?

Goldstein writes that there is a rapid decline in health activities after early adulthood and that activity continues to decrease with age. The middle class is least likely to have health problems since they engage in health activities more than any other group.

2. What were the first signs that society was undergoing a change in its health?

The first exercise fad started in 1870’s with bicycles. Another important change was the beginning of a decline in smoking starting in the 1970’s. It has been found that Americans are getting more obese in general over the past thirty years. Between 1970 and 1985 the number of obese children ages 12-17 increased by 39%. There have been both good and bad signs about Americans health the last half of the century.

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

The Department of Agriculture first introduced food guidelines in 1916. Religious groups have long preached the values of exercise and nutrition since the beginning of America’s history. In 1986 the National Health Interview Survey found that only 7% of Americans consistently exercised at a level that would yield physical benefit. 40% of population did some regular exercise.

4. What was the effect of more people working in offices instead of places where good health was a necessity?

It disrupted the "harmony with nature" that is an ideology of health.

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

No statistics were given but it was stated that "researchers have repeatedly documente the monetary contribution of poor health behaviors- such as sedentary lifestyle, smoking, and high fat diets- to escalating costs in terms of sick and leave and health insurance premiums."

6. What guidelines do experts give for a healthy lifestyle?

The basic ideas of nutrition, exercise, and elimination of smoking are stressed, but Goldstein only gives statistics about what Americans are doing and not what they are supposed to be doing.

7. Can elderly people meet the same demands as younger

Goldstein only writes that there is a decline in healthy activities with age.

8. Should regular exercise be a required part of worker’s daily lives?

Goldstein writes, "Work-site health promotion programs have been accepted more on faith than evidence." By this statement it is possible to conclude that Goldstein does not believe it is a necessity for worker’s to exercise. In the section about nutrition, Goldstein found that even people who knew the benefits of good nutrition were unlikely to practice it. The same could probably be concluded about exercise. It is probably impossible to get people to exercise on a regular basis without them wanting to.

9. Is there a particular era when people’s lifestyles changed?

The period after World War II to the present day is an era where people’s lifestyles have changed for the better and the worse. The knowledge about the harmful effects of smoking is a key change in society. The change from jobs that required hard labor to jobs in urban areas also demanded less physical activity and disrupted the harmony with nature ideology. In the 1960’s the medical world first stated that exercise would be beneficial for people.

Comments

This book should be very helpful when writing the history paper next month. It is hard to find an exact era or decade that the health movement really took off. There are conflicting statistics. Americans are getting more obese, but are also smoking less is an example of this. People have always stressed the benefits of nutrition and exercise in America’s history, but the public does not practice these beliefs. I need to look into how technology has caused changes in our lifestyle.

Synopsis: Tannahill discusses the many aspects of health promotion in this book. She begins by writing about characteristics and definitions of health. She notes that positive health has two components, well-being and fitness. She defines health as a style of living. It is mentioned that the World Health Organization (WHO) believes in a human right to health.

The next topic brought up involves health education, or how health is promoted. Tannahill believes that health promotion must seek to prevent ill-health in such a way to simultaneously enhance positive health. In other words, this means that people should work towards a healthy lifestyle that would prevent sickness and disease, instead of waiting for illness to occur. Tannahill asserts that health education must communicate through influencing the beliefs and behaviors of those with power and also the common man. She also believes that those involved in health care and health promotion must abandon their professional isolation and begin to work through the community rather than on it. Health promotion demands that everyone works together. It is noted that voluntary health codes are in general poor substitutes for compulsion. For instance, cigarette companies try to say they are not influencing kids to start smoking, but their hidden agenda is doing exactly the opposite. Big business is in a strong position to oppose pro-health policies and encourage unhealthy ones in search of profit. These big business players must be go along with health promotion in order for it to be effective. The attitude of chief policy makers must be taken into heavy consideration when setting health promotion goals. Health promotion should be made attractive so more people are likely to adapt to it. The promotion of health is directed towards action on the causes of health.

The third topic considers values of health promotion. Values are defined as preferences which both express attitudes and affect attitudes. The four values of health promotion are self-determination, self-government, sense of responsibility, and self-development. Health promotion values the population as a whole in the context of their daily life, rather than focusing on people who are at risk for disease. Health promotion targets effective and concrete public participation in wellness programs to a high degree. Tannahill also brings up an objection to health promotion. Some people believe that health promotion is attempting to impose a certain lifestyle on us whether we want it or not.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?

Not addressed, but Tannahill believes that all employees should have an equal chance in acquiring a health lifestyle. She calls this "health equity."

2. What were the first signs that society was undergoing a change in its health?

The World Health Organization was created in 1946, so it can be inferred that a need for such an organization became at that time caused by a change in society.

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

Book written about the United Kingdom, did not address.

4. What was the effect of more people working in offices instead of places where good health was a necessity?

. Did not address.

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

Did not address.

6. What guidelines do experts give for a healthy lifestyle?

Tannahill believes that health should be a positive thing and while physical health should be addressed, people cannot forget about their mental and social well-being. This should allow for prevention of physical, social, and mental downfalls. She also suggests that a healthy lifestyle can be a goal shared by a large group, with everyone helping each other reach that goal.

7. Can elderly people meet the same demands as younger people?

Did not address.

8. Should regular exercise be a required part of worker’s daily lives?

Tannahill writes that voluntary codes cannot take the place of laws or compulsion. She does not make an opinion on the whether or not worker’s should be required to exercise, though.

9. Is there a particular era when people’s lifestyles changed?

Since the World Health Organization was formed in 1946 it is evident that a need for change occurred. Since that time tobacco use has declined caused by the decrease of advertising and new laws and requirements.

Comments

This book was very technical and did not bring up a whole of new subjects. It reinforced many of the beliefs supported in other books that I have read which could prove to be helpful. The title was somewhat misleading because a lack of real-life health promotion models was found. I believe I have plenty of information to write a solutions paper now.

Synopsis: Opatz begins by listing the criteria needed before starting a health promotion program. Cost-benefit and cost-effectiveness considerations, prior demonstration of benefits in comparable sites, a time frame for the realization of benefits, and the relevance of the program to health costs and risks to the company should all be addressed. Employee interest in a possible program and negative effects of a plan should also be discussed.

Opatz then writes about the different types of health programs. Smoking cessation is somewhat unpopular because it requires a long time for results to occur and is not an attractive cost containment strategy. He believes worksite health promotion must reduce employees’ health risks, help workers understand their health care benefits, and must target the most common and expensive types of health care claims. The most common claims are circulatory or muscoskeletal mishaps. These mishaps can be reduced with fitness programs, a smoke-free environment, lunchtime sessions on nutrition, prework stretching, and healthy foods on the cafeteria menu.

Many case studies are discussed in the book. In a study conducted at Mesa Petroleum, a significant difference of 1.5 days of sick leave was found between fitness program participants and nonparticipants. Blue Cross/Blue Shield of Indiana in a 4.75 year study, saw a mean difference in health care costs of 24% between participants and nonparticipants in the company’s health promotion program. Screening services are very important to health promotion programs. Six screening programs used in the evaluation of one’s health are tobacco use, percent body fat, blood pressure, total cholesterol, oxygen uptake, and flexibility. As more women enter the work force, employers cannot afford to underestimate the importance of breast cancer screening programs. Some organizations produced health newsletter so that employees would be more educated about such programs.

Opatz makes a strong statement that worksite health programs can have cost without benefits, but they cannot have benefits without costs. He then lists many possible ways in which to measure the success or failure of a health promotion program. Cost of medical benefits per employee, volume of medical services used, disability income payments per employee, absences from work, productivity measures, health risk factors are all ways to measure a health promotion program.

Opatz then summarizes his beliefs in the last chapter. He points out that all evaluations of health programs need to look at the effects on the entire worksite population and not just those who volunteered to participate. The dollar savings inferred from the implentation of health promotion programs has been a primary focus for selling such programs to management. Substantial evidence suggests that health promotion programs have an impact on risk reduction and behavioral change within employee groups. Exercise has been shown to have a positive effect on reducing absenteeism. Physical fitness is a component of health promotion that has an impact on improving worker productivity. He concludes by saying that studies have only been going on for a little more than a decade, and we still have a great deal to learn.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?

Opatz does not address the questions specifically, but suggests in the future that the work force will be older. Employees that have many risk factors will most likely be the most unhealthy employees.

2. What were the first signs that society was undergoing a change in its health?

Not addressed

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

American business first began looking at disease prevention and health promotion in the late 1970’s when they faced dramatic increases in the cost of medical care and health insurance. This put a financial strain on many businesses.

4. What was the effect of more people working in offices instead of places where good health was a necessity?

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

Few numbers were given, but health care costs have risen dramatically in the past two decades. Health care costs are increasing at a rate two to three times higher than inflation. An increased risk of lung cancer, heart disease, and other smoking-related diseases result in higher insurance rates for smokers.

6. What guidelines do experts give for a healthy lifestyle?

Proper nutrition, exercise, lack of tobacco use, and moderate use of alcohol if any are the common guidelines given by Opatz.

7. Can elderly people meet the same demands as younger people?

Did not address.

8. Should regular exercise be a required part of worker’s daily lives?

Opatz believes incentives should be given to employees for keeping a healthy lifestyle. He suggests lower insurance premiums, paid vacations, bonuses for participating in a program, and other ideas that would encourage employees. He never says that workers should be forced into a program.

9. Is there a particular era when people’s lifestyles changed?

The 1970’s was an era that saw businesses and the general public take a closer look at their health and how it effected their daily lives.

Comments

This book was very well written and organized. It should be helpful in the coming months when discussing possible solutions. Examples were given for small, medium, large organizations that started health promotion programs. Many of the things I am reading I have seen in all of the nonfiction books. Different authors takes opposing views in some areas, but agree on most issues.

Synopsis: Robin Bunton begins her discussion on health promotion by defining what exactly it is. She writes, "Health promotion is broader than disease prevention and health education in that those individuals who wished to adopt a healthier lifestyle may be constrained from doing so by environmental and socio-economic factors." She goes on to say we must be careful to blame individuals for his or her health without investigating further in the person’s life, and that any genuine attempt to promote health must tackle the political economy that produces ill health in the first place.

Bunton next lists five criteria for health promotion: health promotion involves the population as a whole, health promotion is directed towards action on the determinants or causes of health, health promotion combines diverse but complimentary methods or approaches, health promotion aims at effective and concrete public participation, health professionals have an important role in nurturing and enabling health promotion. She also suggest that womens’ roles in health promotion must be taken in account.

Bunton then debates several health related questions. Should a smoker be given a transplant even though he says he will continue to smoke afterwards, greatly reducing his chances of survival? Why hasn’t government adopted stronger stances against the tobacco industry? Bunton includes that scientists did not believe smoking was more than a nuisance to most non-smokers until the late 1970’s, when the effects of second hand smoke were realized. Should good health be forced on people? Bunton writes that there is always a price to pay for health, and for some people, health is not a top priority. This brings up the question, is participation in risky lifestyles constitute grounds for differential access to health care?

The next section of the book focuses on accidents, and whether or not they are preventable or able to be calculated. Bunton makes this statement, "Nearly all accidents contain an element of neglect by exposure to risk, except those accidents which are true acts of God. Some would argue that these too can be avoided by appropriate action." She adds, "In theory, all accidents are preventable." The number of accidents can be calculated with an actuarial vision of life and death, knowing that a certain number of accidents will most likely occur.

The final section of the book talks about Americans’ obsession with body image. Bunton writes, "People decide to alter their appearance not at indiscriminate points in their lives but most commonly only when their social circumstances are changing." People, particularly women, might change their appearance to look more "professional", for example, when entering the work force. Bunton believes that cosmetic surgery will grow more popular considering Americans’ tendency to confuse beauty with health.

Answers to Questions

1. Where is the problem of unhealthy employees, mentally or physically most evident?

Bunton believes people whose lifestyles are constricted by environmental and socio-economic factors will be less healthy. We must be careful not to blame these people for their misfortunes without studying all the related factors.

2. What were the first signs that society was undergoing a change in its health?

Some signs that health care was changing include: curative to preventative treatment, institutional to non-institutional environment, specialist to non-specialist, high cost to low cost, individual focused to group focused, and non-participative to participative.

3. When did Americans first become concerned about exercising regularly and maintaining good nutrition?

Not addressed

4. What was the effect of more people working in offices instead of places where good health was a necessity?

These people have less opportunity to practice a healthy lifestyle. They might be constricted by their environment, which prevents them from doing certain habits for wellness.

5. How much time and money are wasted by employees who are absent from work due to health problems that were preventable if they had better exercise and nutrition habits?

Not addressed

6. What guidelines do experts give for a healthy lifestyle?

Besides the ordinary things, Bunton stresses the need to worry less about body weight and image. Being thin or a certain weight does not necessarily mean people will feel better. People often are slightly above weight guidelines, but are in very good health.

7. Can elderly people meet the same demands as younger people?

No, we must confront the social implications of the reality of biological aging and realize that people will slow down over time.

8. Should regular exercise be a required part of worker’s daily lives?

No, health might not be a top priority for some people. They may choose a lifestyle that does not agree with wellness guidelines.

9. Is there a particular era when people’s lifestyles changed?

Not addressed

Comments

Some of the discussion was a little over my head, but for the most part this book offered some fresh viewpoints. I liked that the author took the time to look at the mindset of people who do not practice a healthy lifestyle and the reasons for doing so. I thought that this statement, "People decide to alter their appearance not at indiscriminate points in their lives but most commonly only when their social circumstances are changing," is especially true in high school. Many groups of friends get the same haircut, the short-look is in this year for girls, or wear the same clothes.